What are the treatment options for bruxism (teeth biting) in a young adult?

Treatment of Bruxism (Teeth Grinding/Clenching) in Young Adults

For young adults with bruxism, begin with conservative management including occlusal splint therapy to prevent dental damage, combined with stress reduction techniques and sleep hygiene counseling, reserving pharmacologic interventions like clonazepam or botulinum toxin for severe cases with significant functional impairment. 1, 2

Initial Assessment and Diagnosis

Distinguish between awake and sleep bruxism through targeted history:

• Ask about daytime clenching awareness versus nighttime grinding reported by sleep partners 3, 2
• Document masticatory muscle pain or fatigue, morning headaches, tooth sensitivity, and jaw joint tenderness 3
• Examine for tooth wear patterns, tooth mobility, hypertrophied masseter muscles, and temporomandibular joint tenderness 3
• Polysomnography is not routinely needed unless sleep comorbidities (sleep apnea, periodic limb movements) are suspected 2

First-Line Conservative Management

Occlusal splint therapy is the primary intervention for preventing dental damage:

• Splints successfully prevent tooth wear and reduce grinding sounds, though effects on underlying muscle activity are transient 2
• This protects hard tooth structure and existing dental work 4

Implement behavioral and lifestyle modifications simultaneously:

• Counsel on sleep hygiene optimization and stress reduction techniques 2
• Recommend relaxation exercises, which can improve bruxism symptoms 4
• Address sleep positioning if relevant 3

Consider specialized physiotherapy:

• Physical therapy can improve muscle tension, pain, and restricted jaw movement 4
• Manual therapy techniques may reduce masticatory muscle hyperactivity 1

Pharmacologic Options for Refractory Cases

For severe bruxism with psychiatric or sleep comorbidities:

• Clonazepam at night has been reported to improve sleep bruxism in acute use, though double-blind randomized trials are lacking and routine use cannot be broadly recommended 2
• This should be reserved for cases where conservative measures have failed 2

For severe secondary bruxism causing functional impairment:

• Botulinum toxin injections into masticatory muscles may decrease bruxism for 1-5 months and improve pain and mandibular function 2
• This is specifically indicated when bruxism interferes with speaking, chewing, or swallowing 2
• Effects are temporary, requiring repeat injections 4

Common Pitfalls to Avoid

Do not pursue irreversible dental alterations:

• Avoid routine occlusal adjustment or permanent alteration of dentition as initial therapy 1
• These interventions lack evidence and cannot be reversed if unsuccessful 1

Do not overlook secondary causes:

• Rule out medications that may induce bruxism (SSRIs, stimulants, antipsychotics) 2
• Assess for underlying medical or neurological disorders 2

Do not delay dental referral if significant damage is present:

• Tooth attrition, mobility, or fracture mandates immediate dental evaluation 3
• Progressive dental wear requires protective intervention to prevent further damage 2

Treatment Algorithm

1. All patients: Occlusal splint + sleep hygiene counseling + stress reduction 2
2. If muscle pain/tension predominates: Add specialized physiotherapy 4
3. If refractory with psychiatric comorbidity: Consider trial of clonazepam 2
4. If severe functional impairment: Consider botulinum toxin injections 2
5. If significant dental damage: Urgent dental referral for restorative care 3

The evidence base for bruxism treatment remains limited, with most interventions showing low-quality evidence 2. However, occlusal splints have the strongest support for preventing dental complications, making them the cornerstone of management 2. Behavioral interventions are considered safe despite limited efficacy data 2. Long-term comparative studies are lacking, precluding severity-based treatment guidelines 2.